Chest
Volume 93, Issue 6, June 1988, Pages 1196-1198
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Malignant Pleural Effusion Treated by Tetracycline Sclerotherapy: A Comparison of Single vs Repeated Instillation

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Fifty patients with malignant pleural effusion were randomized to receive one or two doses of tetracycline sclerotherapy. We found that a single sclerotherapy treatment with tetracycline at a dose of 20 mg/kg was as effective as two sclerotherapy treatments and provided symptomatic relief in 46 of the 50 patients.

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PATIENTS AND METHODS

Fifty patients with progressive dyspnea or chest discomfort secondary to malignant pleural effusion were entered into the study between June 1985, and January 1987. The primary malignancies responsible for the pleural effusions are listed in Table 1. Patients were alternately assigned to receive either a single instillation of tetracycline (group 1) or to have instillation of tetracycline on two consecutive days (group 2). The study was approved by the Committee on Human Research, and the

RESULTS

As can be seen from Table 2, there was a total of eight recurrent effusions in the 50 patients, but only four required retreatment. In the 25 group 1 patients who received one dose of tetracycline sclerotherapy, there were four recurrent effusions, three of which required additional treatment. Of the 25 group 2 patients, four had recurrent effusions, but only one was of sufficient size to produce symptoms and require retreatment. All recurrent symptomatic effusions were treated with

DISCUSSION

Malignant pleural effusion occurs in as many as 50 percent of patients with cancer at some point in the course of their disease.2 Symptomatic effusions require treatment for relief of respiratory compromise. The ideal form of treatment should result in little morbidity, have a low cost, provide predictable results, and be easy to administer.

Numerous treatment modalities have been reported for control of malignant pleural effusions.4 Repeated thoracocentesis is an ineffective means of

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Manuscript received August 28; revision accepted November 25.

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